Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Τρίτη 11 Δεκεμβρίου 2018
Correction to: Anatomical locations in the oral cavity where surgical resections of oral squamous cell carcinomas are associated with a close or positive margin—a retrospective study
The following note was inadvertently omitted from the published paper: This work was performed in (partial) fulfillment of the requirements for the first author's obtaining the degree Dr. med. dent.
https://ift.tt/2QwprfW
Stellenwert der Sialendoskopie an deutschen HNO-Kliniken im Jahr 2016
Laryngo-Rhino-Otol
DOI: 10.1055/a-0805-5846
Hintergrund Eine Umfrage aus dem Jahr 2009 zeigte, dass lediglich etwa 24 % aller deutschen HNO-Kliniken die Sialendoskopie anboten. Durch die Wiederholung der Untersuchung im Jahr 2016 sollte die Entwicklung der Sialendoskopie an deutschen HNO-Kliniken reevaluiert werden. Material und Methoden Erneut wurde ein selbstentwickelter Fragebogen mit elf Fragen an alle deutschen HNO-Kliniken verschickt. Der gleiche Fragebogen wurde bereits im Jahr 2009 verwendet. Die aktuellen Umfrageergebnisse wurden mit den Ergebnissen von damals verglichen und ausgewertet. Ergebnisse Die Zahl der sialendoskopierenden HNO-Kliniken konnte sich mehr als verdoppeln. Die Anzahl der Interventionen verdreifachte sich. Die Gründe dafür, dass eine Klinik keine Sialendoskopien durchführte, waren verschieden. Ein Hauptargument war ein Mangel an Patienten. Kaum Veränderungen ergaben sich bei ambulanten und stationären Therapien und der Eingriffsdauer. Die Sonographie wird unverändert von allen Kliniken präoperativ durchgeführt. Schlussfolgerung Auffallend ist, dass bei zunehmender Anzahl an Kliniken, die die Sialendoskopie anbieten und steigenden Fallzahlen, ein Teil der Kliniken einen Patientenmangel angibt. Dies könnte für die Etablierung von spezialisierten Zentren sprechen. Inzwischen werden neben der obstruktiven Sialadenitis weitere Krankheitsbilder durch die Sialendoskopie therapiert. Die Sonographie bleibt die präoperative Diagnostik der Wahl. Die Auswertung zeigt, dass die Sialendoskopie in den vergangenen sieben Jahren eine steigende Akzeptanz an deutschen HNO-Kliniken erfahren hat.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2Qq5OG8
Donor-derived hepatocytes in human hematopoietic cell transplant recipients: evidence of fusion
Abstract
Reconstitution of hepatocytes by hematopoietic stem cells—a phenomenon which occurs in rodents under highly selective conditions—results from infrequent fusion between incoming myelomonocytes and host hepatocytes, with subsequent proliferation. Human hematopoietic stem cell transplant recipients have been little studied, with some support for transdifferentiation (direct differentiation). We studied routinely obtained autopsy liver tissue of four female hematopoietic cell transplant recipients with male donors, using a highly specific conjoint immunohistochemistry in situ hybridization light microscopic technique. Hepatocyte nuclei were identified by cytokeratin (Cam5.2) staining and evaluated for X and Y chromosome content. Over 1.6 million hepatocytes were assessed for rare instances of donor origin, revealing a Y chromosome in 67. Mixed tetraploids (XXXY) and their nuclear truncation products (XXY, XY, Y) were directly demonstrated, with no detection of the male tetraploids (XXYY) that may result from transdifferentiation with subsequent tetraploidization, nor their unique truncation products (XYY, YY), implicating fusion as the mechanism. To determine whether it is the sole mechanism, we modeled the chromosome distribution based on the same probability of detection of each X chromosome, deriving parameters of sensitivity and female tetraploidy by best fit. We then hypothesized that the distribution of Y chromosome–containing cells could be predicted by a similar model. After modification to account for "clumpy" Y chromosomes, the observed results were in accord with the predicted results (p = 0.6). These results suggest that all the Y-containing cells, including apparent XY cells, derive from mixed tetraploids, consistent with fusion as the sole mechanism.
https://ift.tt/2RTkA4M
Perioperative Intravenous Fluid in Children Undergoing Brain Tumor Resection: Balancing the Threats to Homeostasis
No abstract availablehttps://ift.tt/2B9Ie6b
Epidemiology and Resource Utilization of Simple Febrile Seizure-associated Hospitalizations in the United States, 2003-2012
Background: Simple febrile seizure (SFS) affects 2% to 4% of children under 6 years of age. The purpose of this study is to examine the epidemiologic patterns and resource utilization of SFS-associated hospitalizations in children aged younger than 6 years of age in the United States. Materials and Methods: This study is a serial, retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Databases for the years 2003, 2006, 2009, and 2012. SFS-associated hospitalizations were identified based on International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis code 780.31. We calculated the proportion of hospitalizations in pediatric patients under 6 years of age due to SFS and all other nonbirth causes, the rate of SFS-associated hospitalizations per 100,000 population, the mean length of stay and inflation-adjusted hospital costs of SFS-associated hospitalizations, as well as patient demographics and hospital characteristics. Results: From 2003 to 2012, the weighted proportion of hospitalizations due to SFS declined from 0.83% to 0.41% (Phttps://ift.tt/2C4ItAW
Developmental Neurotoxicity: An Update
In the section of "Developmental Neurotoxicity: An Update" of the Pediatric Anesthesia Neurodevelopmental Assessment (PANDA) symposium 2018 the speakers presented the current literature in translational and clinical research. Dr. Brambrink spoke about translational research in anesthetic neurotoxicity, beginning with discovery in the rodent model, then focusing on evidence from nonhuman primates. Dr. Waspe applied the methodology of Adverse Outcome Pathways from the field of toxicology to developmental neurotoxicity of anesthetics. Dr. O'Leary presented relevant clinical studies that were published in 2017 divided by a focus on academic performance, clinical outcomes or diagnoses, or neuropsychological testing.
https://ift.tt/2UB5bbh
https://ift.tt/2UB5bbh
Engaging Stakeholders to Promote Safe Anesthesia and Sedation Care in Young Children
An important aspect of any research endeavor is engaging various stakeholders to work toward the common goal of pushing knowledge forward about the question at hand. Research into pediatric anesthetic neurotoxicity could benefit greatly from interventions designed to improve the efforts and dedication of government agencies, pharmaceutical companies, research communities, and most importantly, patients. The Pediatric Anesthesia Neurodevelopment Assessment (PANDA) symposium is a biennial meeting where updates in research in the field are presented, and issues relevant to the community are discussed in round table discussions. Here, we summarize a discussion that took place at the 2018 meeting regarding new methods of engaging various stakeholders, as well as perspectives from other stakeholders. Topics discussed included an online portal to better reach patients, experiences with a public-private partnership, steps by the National Institutes of Health to improve engagement with research and improve the dissemination of results, and the experiences of the United States Food and Drug Administration attempting to improve stakeholder engagement following the passage of a new law to promote drug development. The round table discussion provided interesting insights into a critical research topic, and shared first-hand experience of attempts to improve engagement with a variety of stakeholders.
https://ift.tt/2Uvl7M2
https://ift.tt/2Uvl7M2
Anesthesia and Neurodevelopment in Children: Many Important Questions Remain Unanswered
No abstract availablehttps://ift.tt/2B9I7HN
Using Neuroimaging to Study the Effects of Pain, Analgesia, and Anesthesia on Brain Development
Neuroimaging has been increasingly used as a modality to study the impact of pain, analgesia, and anesthetics on pediatric neurodevelopment. The sixth biennial Pediatric Anesthesia Neurodevelopmental Assessment (PANDA) Symposium addressed the 2016 US Food and Drug Administration drug safety warning regarding the potential neurotoxic effects of commonly used anesthetic and sedative medications in children, and included a session discussing the use of various neuroimaging techniques, to detect structural, metabolic, and functional brain changes that can occur with exposure to pain and to anesthetic medications. The presenters concluded that advanced multimodal magnetic resonance imaging techniques are useful in detecting the aforementioned changes, which were found to be pain-specific and anesthetic agent-specific.
https://ift.tt/2UCDMpb
https://ift.tt/2UCDMpb
Cognitive Aids for the Diagnosis and Treatment of Neuroanesthetic Emergencies: Consensus Guidelines on Behalf of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) Education Committee
Cognitive aids and evidence-based checklists are frequently utilized in complex situations across many disciplines and sectors. The purpose of such aids is not simply to provide instruction so as to fulfill a task, but rather to ensure that all contingencies related to the emergency are considered and accounted for and that the task at hand is completed fully, despite possible distractions. Furthermore, utilization of a checklist enhances communication to all team members by allowing all stakeholders to know and understand exactly what is occurring, what has been accomplished, and what remains to be done. Here we present a set of evidence-based critical event cognitive aids for neuroanesthesia emergencies developed by the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) Education Committee.https://ift.tt/2BeABvk
Protecting the Brain With Xenon Anesthesia for Neurosurgical Procedures
Xenon possesses some, but not all, of the clinical features of an ideal anesthetic agent. Besides well-known advantages of rapid awakening, stable hemodynamics and lack of biotransformation, preclinical data lead to the expectation of xenon's advantageous use for settings of acute ongoing brain injury; a single randomized clinical trial using an imaging biomarker for assessing brain injury corroborated xenon's preclinical efficacy in protecting the brain from further injury. In this review, we discuss the mechanisms and hence the putative applications of xenon for brain protection in neurosurgery. Although the expense of this rare monoatomic gas will likely prevent its widespread penetration into routine clinical neurosurgical practice, we draw attention to the theoretical benefits of xenon anesthesia over other anesthetic regimens for awake craniotomy and for neurosurgery in older, high-risk, and sicker patients.https://ift.tt/2B9HZrN
Balanced Crystalloids Versus Saline for Perioperative Intravenous Fluid Administration in Children Undergoing Neurosurgery: A Randomized Clinical Trial
Background: Balanced crystalloid solutions induce less hyperchloremia than normal saline, but their role as primary fluid replacement for children undergoing surgery is unestablished. We hypothesized that balanced crystalloids induce less chloride and metabolic derangements than 0.9% saline solutions in children undergoing brain tumor resection. Methods: In total, 53 patients (age range, 6 mo to 12 y) were randomized to receive balanced crystalloid (balanced group) or 0.9% saline solution (saline group) during and after (for 24 h) brain tumor resection. Serum electrolyte and arterial blood gas analyses were performed at the beginning of surgery (baseline), after surgery, and at postoperative day 1. The primary trial outcome was the absolute difference in serum chloride concentrations (post-preopΔCl−) measured after surgery and at baseline. Secondary outcomes included the post-preopΔ of other electrolytes and base excess (BE); hyperchloremic acidosis incidence; and the brain relaxation score, a 4-point scale evaluated by the surgeon for assessing brain edema. Results: Saline infusion increased post-preopΔCl (6 [3.5; 8.5] mmol/L) compared with balanced crystalloid (0 [−1.0; 3.0] mmol/L; Phttps://ift.tt/2B9HWfB
The Effects of Leukocyte Filtration on Cell Salvaged Autologous Blood Transfusion on Lung Function and Lung Inflammatory and Oxidative Stress Reactions in Elderly Patients Undergoing Lumbar Spinal Surgery
Background: This study was designed to investigate the effects of leukocyte filtration of autologous salvaged blood on lung function, lung inflammatory reaction, and oxidative stress reaction in elderly patients undergoing lumbar spinal surgery. Materials and Methods: Sixty elderly patients undergoing lumbar spinal surgery were randomly divided into 2 groups: Leukocyte Filter group and Control group. Serum levels of inflammatory markers including white blood cell and polymorphonuclear count, neutrophil elastase, serum surfactant protein A, methane dicarboxylic aldehyde, superoxide dismutase, interleukin (IL)-6, IL-8, tumor necrosis factor-α, and respiratory function markers including dynamic respiratory system compliance, oxygenation index, and respiratory index were measured immediately before induction of anesthesia (T0), immediately before blood transfusion (T1), and 1 (T2), 6 (T3), and 12 hours (T4) after end of blood transfusion. Results: The Leukocyte Filter group had higher dynamic respiratory system compliance at T2, oxygenation index at T2 and T3, respiratory index and superoxide dismutase at T2, T3, and T4 than those in the Control group (Phttps://ift.tt/2B9HTjV
Analgesia Nociception Index Monitoring During Supratentorial Craniotomy
Background: Objective monitoring of pain during and after surgery has been elusive. Recently, Analgesia Nociception Index (ANI) monitor based on the high frequency component of heart rate variability has been launched into clinical practice. We monitored analgesia during craniotomy using ANI monitor and compared it with cardiovascular parameters and response entropy (RE) of entropy monitor. Materials and Methods: In 21 patients undergoing a craniotomy for a supratentorial lesion, we monitored ANI, heart rate (HR), mean arterial pressure (MAP), state entropy, and RE throughout the surgery. Also, ANI, hemodynamic variables and spectral entropy values were noted at the times of maximal stimulation, such as induction, intubation, head pin fixation, skin incision, craniotomy, durotomy, and skin closure. We also compared ANI with RE during administration of bolus doses of fentanyl. Results: There was an inverse correlation between ANI values and the hemodynamic changes. When the HR and MAP increased, ANI decreased suggesting a good correlation between hemodynamics and ANI values during the times of maximal stimulation. State entropy and RE did not change significantly in response to bolus doses of fentanyl administered during the course of surgery, while ANI increased significantly. Conclusion: In neurosurgical patients undergoing elective supratentorial craniotomy, ANI measures response to noxious stimuli with at least as much reliability as hemodynamic variables and changes in ANI parallel the changes in HR and MAP. ANI is superior to RE for measurement of response to noxious stimuli.https://ift.tt/2BaEWzn
Outcomes of Anesthesia Selection in Endovascular Treatment of Acute Ischemic Stroke
Background: The association between anesthesia type and outcomes in patients with acute ischemic stroke undergoing endovascular treatment (EVT) remains a subject of ongoing debate. Methods: This prospective nonrandomized controlled trial included 149 consecutive patients with acute anterior circulation stroke who underwent EVT. The primary outcome was functional independence assessed by the modified Rankin Scale (mRS) after 3 months. Results: A total of 105 (70.5%) and 44 (29.5%) patients undergoing EVT who received conscious sedation (CS) and general anesthesia (GA), respectively. The patients who received GA had similar demographics and basic National Institute of Health Stroke Scale scores (17 vs. 16, P>0.05) as the patients who received CS. The recanalization time (304 vs. 311 min, P=0.940) and the recanalization rate (86.4% vs. 84.1%, P=0.170) did not differ between the patients receiving the different types of anesthesia. The National Institute of Health Stroke Scale at 24 hours was lower in the patients who received CS than in those who received GA (β=−2.26, 95% confidence interval, −5.30 to 0.79). The independence (modified Rankin Scale score 0 to 2) at 3 months was equal between patients who received GA and those who received CS (odds ratio=0.73, 95% confidence interval, 0.32-1.68). The mortality and the morbidity rates did not differ. Conclusions: The data indicated that the selection of GA or CS during EVT had no impact on the independent outcomes of patients with anterior circulation occlusion.https://ift.tt/2B9lwuW
Prolonged Anesthetic Exposure in Children and Factors Associated With Exposure Duration
Introduction: Anesthetic exposure duration has come under scrutiny because of a Food and Drug Administration warning against prolonged use of anesthesia in children, defined as exposures longer than 3 hours. Methods: Data for 2,613,344 pediatric anesthetic records from the American Society of Anesthesiologist's National Anesthesia Clinical Outcomes Registry from 2010 to 2015 were analyzed to describe anesthetic duration and the prevalence of prolonged exposures in children. Common pediatric inpatient procedures were independently assessed to determine factors associated with exposure duration. Results: The overall mean pediatric anesthetic duration was 83.3±107.4 minutes (median, 57 min). Prolonged exposures comprised 7% of pediatric anesthetic records, and 15% of anesthetic records in infants. After restricting to common pediatric inpatient procedures (n=96,603) and adjusting for procedure type using a Poisson model, compared with children 10 years or older, exposures in infants were 20.5% longer (anesthetic duration ratio [ADR], 1.205; 95% confidence interval [CI], 1.202–1.208). Longer exposures were also seen with a variety of other patient and hospital factors including ASA 4 patients versus ASA 1 patients, (ADR, 1.381; 95% CI, 1.376-1.386), and university hospitals versus surgery centers (ADR, 1.241; 95% CI, 1.236-1.246). Conclusions: Most pediatric anesthetic exposures lasthttps://ift.tt/2UAPIYD
Radiographic Predictors of Difficult Laryngoscopy in Acromegaly Patients
Background: Patients with acromegaly have a high risk of difficult laryngoscopy. However, clinical predictors, such as upper lip bite test or modified Mallampati class, show limited predictive performance for difficult laryngoscopy in such patients. In this retrospective study, we evaluated radiographic indices obtained from skull lateral x-ray and ostiomeatal unit computed tomography images to predict difficult laryngoscopy in acromegaly patients. Materials and Methods: Data on demographics, preoperative serum levels of pituitary hormones, and radiographic indices were collected from 90 acromegaly patients that underwent transsphenoidal removal for pituitary tumor from January 2010 to December 2016. Difficult laryngoscopy was defined as Cormack-Lehane grade ≥III. Results: Difficult laryngoscopy occurred in 21 (23%) patients. In univariate analysis, age and radiographic indices indicating tongue size, such as tongue area (TA) on ostiomeatal unit computed tomography, linear distance from the alveolar line of the mandible to the hyoid bone, and linear distance from the interior border of the mandible to the hyoid bone on skull lateral x-ray, were associated with difficult laryngoscopy. In multivariate analysis, age (odds ratio [95% confidence interval], 1.084 [1.037-1.190]; P=0.002) and TA (1.002 [1.000-1.003], P=0.014) were independent risk factors for difficult laryngoscopy. The area under the curve of the combined model of age and TA was 0.80. Conclusions: Old age and radiographic predictors indicating large tongue size (large TA, long alveolar line of the mandible to the hyoid bone and mandible to the hyoid bone) were associated with an increased rate of difficult laryngoscopy in acromegaly patients. Preoperative radiographic measurements of tongue size can be helpful for safe airway management in such patients.https://ift.tt/2B9HM7Z
A Summary of Preclinical Poster Presentations at the Sixth Biennial Pediatric Anesthesia Neurodevelopment Assessment (PANDA) Symposium
The potential for long-term neurotoxic effects of anesthetics on the developing human brain has led to intensified research in this area. To date, the human evidence has been inconclusive, but a large body of animal evidence continues to demonstrate cause for concern. On April 14 and 15, 2018 the sixth biennial Pediatric Anesthesia and Neurodevelopmental Assessment (PANDA) study symposium was held at Morgan Stanley Children's Hospital of New York. This symposium brought together clinicians and researchers and served as a platform to review preclinical and clinical data related to anesthesia and neurotoxicity in developing brains. The program participants included many active investigators in the field of anesthesia neurotoxicity as well as stakeholders from different backgrounds with the common interest of potential anesthetic neurotoxicity in children. The moderated poster session included presentations of preclinical animal research studies. These studies focused on defining the anesthetic-induced neurotoxicity phenotype, understanding the mechanism of injury and discovering potential inhibitors of neurotoxic effects.
https://ift.tt/2UyZcDK
https://ift.tt/2UyZcDK
Chemical Eye Injury in a Case of Cervical Spine Surgery
No abstract availablehttps://ift.tt/2UBYSnG
The Impact of Intraoperative Magnetic Resonance Imaging on Patient Safety Management During Awake Craniotomy
Background: Awake craniotomy paired with intraoperative magnetic resonance imaging (iMRI) is now the established technique for maximizing surgical resection, while preserving neurological function. However, leaving an unsecured airway patient in the iMRI gantry represents considerable risk. Our study aimed at identifying the incidence of critical adverse events in unsecured airway patients during iMRI as part of awake craniotomy. Materials and Methods: We conducted a clinical chart review of consecutive awake craniotomies performed between November 1999 and December 2015. Sequences of iMRI performed without invasive airway management were selected for assessment and the incidence of critical adverse events, including general convulsive seizure, respiratory arrest, nausea/vomiting and agitation, was identified. Results: Critical adverse events occurred in 21 of 356 unsecured airway patients within 24 of the 579 iMRI sequences. In cases using the low-field strength open MRI scanner, emergency termination of scans due to patient decline was recorded in only 4 cases: no cases of cardiac arrest, accidental death, or thermal injury were recorded. Compared with cardiovascular monitoring, patient respiratory status was poorly recorded. Conclusions: In terms of anesthesia, concurrent use of iMRI for awake craniotomy is clinically acceptable providing potential intraoperative complications can be controlled. Further, the configuration of the iMRI scanner as well as the reduced exposure from the lower magnetic field strength was found to impact patient safety management. Therefore when a conscious patient is left in the gantry without airway support, it is advisable that levels of oxygenation and ventilation should be monitored at all times.https://ift.tt/2Bc9DV2
A mathematical approach improves the predictability of length of hospitalization due to acute odontogenic infection: A retrospective investigation of 303 patients
Increasing rates of hospitalization of patients diagnosed with acute odontogenic infection have become a burden for public health care, with significant economic concerns. The aim of this study was to investigate factors that tend to prolong hospital length of stay (LOS) in the treatment of severe infections. We present a statistical model that enables the prediction of LOS by exposing the feasibility of the essential statistical determinants.
https://ift.tt/2PyvACT
Reliability and intra-examiner agreement of orthodontic model analysis with a digital caliper on plaster and printed dental models
Abstract
Objective
To investigate if orthodontic model analysis with a digital caliper can be interchangeably performed between plaster and printed dental models.
Materials and methods
Forty-eight plaster models were digitized with orthoX®scan (DENTAURUM) and 48 counterparts were printed with Objet30 Dental Prime (Stratasys). One examiner performed five repeated orthodontic model analyses (41 outcomes) with a digital caliper in each plaster and the corresponding printed model and was externally validated by a second examiner. Inter- and intra-examiner reliability and error were evaluated with intraclass correlation coefficients (ICCs) and Dahlberg's formula, intra-examiner agreement with Bland-Altman analyses and Lin's correlation coefficients (CCCs), and changing bias with regression analyses.
Results
Inter- and intra-examiner ICCs and Dahlberg's error were ≥ 0.75 and ≤ 0.5 mm, respectively, for most outcomes in both plaster and printed models. Intra-examiner agreement (systematic bias) between plaster and printed models ranged from − 0.45 to 0.45 mm. Ranges of limits of agreement were wide for cumulative outcomes, such as crowding maxilla and mandible (2.69 mm and 3.07 mm around zero, respectively). Tooth widths were measured slightly larger in printed models. Lin's CCCs were ≥ 0.87 for all the outcomes between plaster and printed models, while no changing bias was detected.
Conclusion
If orthodontic model analyses are consistently performed, plaster casts and their corresponding printed models obtained with orthoX®scan and Objet30 Dental Prime can be interchangeably used for clinical purposes in orthodontics.
Clinical relevance
Orthodontic model analysis is important in treatment planning and printed dental models need to be validated regarding this diagnostic procedure.
https://ift.tt/2Py9ZKG
The role of the skin microbiome in atopic dermatitis
Atopic dermatitis (AD) is a common inflammatory skin disease associated with significant medical burden, affecting 15-20% of children and 1-3% of adults worldwide.1 The prevalence of AD has increased by 2-3 folds during the past decade in Western countries. While the cause of this increase remains unknown, meta-analyses have indicated that the risk of AD is lower when associated with potentially protective environmental factors during childhood such as three or more siblings, day care, pet ownership and farm residence.
https://ift.tt/2rtUaes
The Asthma Controller Step-down Yardstick
Guidelines for asthma recommend a series of treatment steps (Figure 1) as a framework for disease management.1,2 The steps allow individualized adjustments in controller therapy in an upward or downward manner in response to a patient's level of asthma control over a period of time. For patients with inadequately controlled asthma, a step-up is recommended.1,2 Strategies for stepping up controller therapy are described in detail in the adult and pediatric Asthma Yardsticks.3,4 For patients whose asthma has been well controlled for at least 3 months (or longer for the highest risk patients), controller treatment may be stepped down.
https://ift.tt/2G8qmOv
Basic chemical peeling—superficial and medium-depth peels
Chemical peeling, or chemexfoliation, has been used for centuries to improve signs of ultraviolet light-induced sun damage. Over the last 30 years, the science behind chemical peeling has evolved, increasing our understanding of the role of peeling ingredients and treatment indications. The depth of peels is directly related to improved results and to the number of complications that can occur. Key principles for superficial and medium depth peeling are discussed, as well as appropriate indications for these treatments.
https://ift.tt/2En8TjK
Advanced chemical peels: phenol-croton oil peel
Once considered the gold standard for deep facial resurfacing, the classical Baker-Gordon phenol-croton oil peel has largely been replaced by formulas with lower concentrations of phenol and croton oil. The improved safety profile of deep peels has ushered in a new era in chemical peeling. Wrinkles can be improved and skin tightened with more subtle and natural results. No longer does a deep peel denote "alabaster white" facial depigmentation with complete effacement of wrinkles. The research of Dr.
https://ift.tt/2EcFx6K
Tezepelumab, an anti-TSLP monoclonal antibody, in the treatment of moderate to severe atopic dermatitis: A randomized phase 2a clinical trial
•Thymic stromal lymphopoietin may initiate inflammation and therefore be a key target for atopic dermatitis treatmentHere, thymic stromal lymphopoietin blockade shows limited efficacy after 12 weeks' treatment; findings at later time points suggest that future clinical trials may require longer treatment periods to determine a significant treatment effect
https://ift.tt/2Ee387e
Optical coherence tomography imaging of melanoma skin cancer
Abstract
No consensus guidelines exist on the use of optical coherence tomography (OCT) for diagnosis of cutaneous melanoma. The objectives of this review are to provide a descriptive review of the literature on characteristics of cutaneous melanomas seen on high-definition OCT (HD-OCT), speckle variance OCT (SV-OCT), and conventional OCT and to compare their diagnostic ability with that of histopathology. A review of PubMed and Google Scholar identified all available literature on OCT in melanoma skin cancer that included all in vivo and ex vivo studies on human or human tissues and excluded all studies on non-human subjects or animal studies. Two hundred nine abstracts were considered for evaluation, 31 abstracts were selected for manuscript review, and 14 abstracts were included that met all criteria. Diagnoses of MIS and MM using HD-OCT and SV-OCT were consistently reported to correlate with histopathology. However, accuracy of diagnosis using conventional OCT varied. Most authors agreed that it was difficult to differentiate MM from benign nevi using conventional OCT. HD-OCT, SV-OCT, and conventional OCT show promise for visualizing cutaneous melanoma. The use of OCT in diagnosis of melanoma is rarely reported in the literature. There is a need to increase and standardize reporting of OCT for diagnosis of cutaneous melanoma.
https://ift.tt/2B8yA3C
Estrogen receptor gene is associated with dental fluorosis in Brazilian children
Abstract
Objectives
The aim of this study was investigate the association between genetic polymorphisms in ESR1, ESR2, and ESRRB and dental fluorosis (DF) in a well-characterized sample of children from Curitiba, Brazil.
Material and methods
From a representative sample of 538 children, 12-year-old were evaluated. DF was assessed in erupted permanent teeth by the Dean's index modified. Fourteen polymorphisms were selected in intronic and intergenic regions of ESR1, ESR2, and ESRRB and genotyped in genomic DNA source from saliva using TaqMan chemistry and end-point analysis. Allele and genotype distributions between DF and DF free groups were analyzed using the Epi Info 7.2. Chi-square or Fisher's exact tests at a level of significance of 5% and odds ratios calculations with 95% confidence intervals were used to determine the statistical associations.
Results
Among 538 children, 147 were DF and 391 were DF free. Genotype distribution for the polymorphism rs12154178 in ESR1 was different between the two groups (p = 0.037; OR = 0.91; CI = 0.67–1.22). The dominant model analysis (AA+AC vs. CC) demonstrated that CC is a protective factor for DF (p = 0.038; OR = 0.51, 0.27–0.97 95% CI). We did not find differences in frequency distributions in the other evaluated polymorphisms.
Conclusion
This study provides evidence that ESR1 is associated with DF.
Clinical relevance
Dental fluorosis is an important condition that affects the mineralized tissues of the teeth. In severe cases, the treatment takes time and is extremely costly. This research provides evidences that there are genetic factors involved in dental fluorosis and will help professionals to plan more precise strategies to reduce dental fluorosis occurrence.
https://ift.tt/2rvSsJu
Cytokine levels in crevicular fluid associated with compliance during periodontal maintenance therapy
Abstract
Objectives
To longitudinally evaluate the effects of compliance during periodontal maintenance therapy (PMT) on cytokines levels and its relation to periodontal status.
Materials and methods
Ninety-one eligible individuals were selected from a 6-year prospective study with 212 individuals in PMT. From this total, 28 regular compliers (RC) were randomly selected and matched for age and gender with 28 irregular compliers (IC). All participants were non-smokers and non-diabetic. Periodontal parameters and gingival crevicular fluid samples were collected in 5 times: T1 [prior to active periodontal therapy (APT)], T2 (after APT), T3 (2 years), T4 (4 years), and T5 (6 years). Levels of IL-6, IL-10, IL-1β, TNF-α, and MMP-8 were quantified through ELISA.
Results
RC presented better clinical periodontal status over time when compared to IC. A significant reduction in the levels of IL-1β, TNF-α, MMP-8, and IL-6 was observed among RC along time (from T1 to T5). Levels of IL-1 were similar among groups. By contrast, levels of IL-6 and TNF-α increased over time in IC individuals. Levels of IL-10 increased among RC and reduced among IC.
Conclusions
The inflammatory cytokines IL-1, TNF-α, IL-6, and MMP-8 were correlated with worse clinical parameters among IC, while IL-10 was associated with an improvement in clinical parameters among RC. These results reinforce the role of these cytokines in the pathogenesis of periodontitis, as well as their role as markers to monitoring the progression of the periodontitis.
Clinical relevance
Regular compliance during 6-year period the PMT sustained clinical and immunological benefits obtained after active periodontal therapy.
https://ift.tt/2GdNFXn
The effects of repeated applications of antimicrobial photodynamic therapy in the treatment of residual periodontal pockets: a systematic review
Abstract
The aim of this study was to assess the effects of repeated applications of antimicrobial photodynamic therapy (aPDT) on the non-surgical periodontal treatment of residual pockets. This work was performed and reported according to the Cochrane and PRISMA recommendations, respectively, and registered at the PROSPERO registry (number CRD42017058403). An extensive search of the biomedical literature was conducted on four databases from January 1960 to August 2018, followed by hand searching. Analysis of the quality of the selected studies was based on the risk of bias. Only two randomised controlled clinical trials (RCTs) met the inclusion criteria although they had unclear risk of bias. One study showed that repeated applications of aPDT in association with conventional non-surgical treatment during periodontal maintenance improved all clinical outcomes after 6 months. The other study, which assessed the effects of repeated applications of aPDT in association with ultrasound debridement on periodontal pathogens, showed no significant reduction of the main pathogens after 3–6 months but reported reductions of probing pocket depth and C-reactive protein after 3 and 6 months, respectively, compared to mechanical therapy alone. Concluding, it was not possible to state that repeated applications of aPDT, in association with non-surgical treatment of residual pockets, have effective clinical effects in the periodontal maintenance therapy. Although one can consider that aPDT is a promising adjuvant therapy, it is still necessary to carry out more RCTs with low risk of bias in order to confirm or refute the benefits of multiple applications for residual periodontal pockets.
https://ift.tt/2QKVFD9
Epithelioid cell granuloma with caseating necrosis possibly caused by periapical periodontitis: a case report
Epithelioid cell granuloma with caseating necrosis is a typical pathological finding in tuberculosis. While specific inflammation, including that related to tuberculosis, can induce caseating granuloma formati...
https://ift.tt/2QT3U0l
Clinical evaluation of direct pulp capping using a calcium silicate cement—treatment outcomes over an average period of 2.3 years
Abstract
Objectives
This study aims to assess the treatment outcomes of direct pulp capping with a calcium silicate cement (Biodentine) after caries excavation.
Materials and methods
A total of 245 teeth of 226 patients diagnosed to be clinical healthy or showing spontaneous pain were directly capped. The teeth were examined 0.19 to 7.4 (mean 2.3 ± 2.04) years after treatment. The following data were recorded: age and sex of the patient, type of tooth and restoration (glass ionomer cement [GIC], amalgam, composite resin, ceramic, gold) and symptoms before or after treatment. The evaluation of the treatment was carried out by sensibility and percussion testing and by the patient's questioning. A positive sensibility test, a negative percussion test, the absence of swelling and discomfort were considered as treatment success. Survival analysis was performed using the Kaplan-Meier, log-rank, Chi-square and Fisher's exact test, respectively.
Results
After an average period of 2.3 years, 86.0% of the teeth remained vital; the survival rate after 7.4 years was 83.4%. The treatment outcome was significantly worse for cavities restored with GIC compared to all other restorative materials (p < 0.05). All other evaluated factors had no significant influence on the success rate (p > 0.05).
Conclusion
Exposed pulps of asymptomatic vital permanent teeth and teeth with spontaneous pain before treatment can be successfully capped directly using Biodentine. A subsequent restoration with GIC does not appear to be suitable as it significantly reduces the success of the treatment.
Clinical relevance
Direct pulp capping can be done successfully with this type of calcium silicate cement.
https://ift.tt/2ry8D9g
Isotretinoin and Candida immunotherapy for recalcitrant warts in solid organ transplant recipients
Abstract
Treatment of recalcitrant warts in solid organ transplant recipients (SOTR) can pose a therapeutic challenge for dermatologists. Successful treatment of recalcitrant warts can serve as secondary prevention for skin cancer in those with chronic immunosuppression. Given the heterogeneity of associated comorbid conditions in SOTR, clinical trials are difficult to conduct in this high‐risk population, therefore, our clinical practice is mostly driven by observed responses from studies in immunocompetent patients or from case reports of immunocompromised patients. The combination of systemic retinoids and candida immunotherapy likely provide the most effective treatment for recalcitrant warts in SOTR. However, many SOTR have chronic renal insufficiency and are not candidates for Acitretin therapy. We provide two cases of recalcitrant warts in SOTR successfully treated with Isotretinoin in the setting of impaired renal function.
This article is protected by copyright. All rights reserved.
https://ift.tt/2SFMils
Anticaries effect of toothpaste with nano-sized sodium hexametaphosphate
Abstract
Objective
To evaluate the effect of a fluoride toothpaste containing nano-sized sodium hexametaphosphate (HMPnano) on enamel demineralization on the biochemical composition and insoluble extracellular polysaccharide (EPS) in biofilm formed in situ.
Methods
This crossover double-blind study consisted of four phases (7 days each), in which 12 volunteers wore intraoral appliances containing four enamel bovine blocks. The cariogenic challenge was performed using 30% sucrose solution (6×/day). Blocks were treated 3×/day with the following toothpastes: no F/HMP/HMPnano (Placebo), conventional fluoride toothpaste, 1100 ppm F (1100F), 1100F + 0.5% micrometric HMP (1100F/HMP), and 1100F + 0.5% nano-sized HMP (1100F/HMPnano). The percentage of surface hardness loss (%SH), integrated loss of subsurface hardness (ΔKHN), and enamel calcium (Ca), phosphorus (P), and fluoride (F) were determined. Moreover, biofilms formed on the blocks were analyzed for F, Ca, P, and insoluble extracellular polysaccharide (EPS) concentrations. Data were analyzed using one-way ANOVA, followed by Student–Newman–Keuls' test (p < 0.001).
Results
1100F/HMPnano promoted the lowest %SH and ΔKHN among all groups (p < 0.001). The addition of HMPnano to 1100F significantly increased Ca concentrations (p < 0.001). The 1100F/HMPnano promoted lower values of EPS when compared with 1100F (~ 70%) (p < 0.001) and higher values of fluoride and calcium in the biofilms (p < 0.001).
Conclusion
1100F/HMPnano demonstrated a greater protective effect against enamel demineralization and on the composition of biofilm in situ when compared to 1100F toothpaste.
Clinical relevance
This toothpaste could be a viable alternative to patients at high risk of caries.
https://ift.tt/2PuTtes
Identification of salivary metabolites for oral squamous cell carcinoma and oral epithelial dysplasia screening from persistent suspicious oral mucosal lesions
Abstract
Objective
To identify salivary metabolite biomarkers to differentiate patients with oral squamous cell carcinoma and oral epithelial dysplasia (OSCC/OED) from those with persistent suspicious oral mucosal lesions (PSOML).
Subjects and methods
Whole unstimulated saliva samples were collected from age-, sex-, and race-matched patients who had a lesion in the oral cavity and for whom open biopsies were performed. The patients included OSCC (n = 6), OED (n = 10), and PSOML (n = 32). Hydrophilic metabolites in saliva samples were comprehensively analyzed using capillary electrophoresis mass spectrometry. To evaluate the discrimination ability of a combination of multiple markers, a multiple logistic regression (MLR) model was developed to differentiate OSCC/OED from PSOML.
Results
Six metabolites were significantly different in OSCC/OED compared with PSOML. From these six metabolites, ornithine, o-hydroxybenzoate, and ribose 5-phosphate (R5P) were used to develop the MLR model, which resulted in a high value for the area under receiver operating characteristic curve (AUC 0.871, 95% confidential interval (CI) 0.760–0.982; p < 0.001) to discriminate OSCC/OED from PSOML.
Conclusions
This is the first study to identify salivary metabolites that discriminate OSCC/OED from PSOML rather than from healthy controls. The profiles of salivary metabolites were significantly different between OSCC/OED and PSOML. The ability to discriminate OSCC/OED from PSOML is important for dentists who are not oral surgery specialists. These salivary metabolites showed potential for non-invasive screening to discriminate OSCC/OED from PSOML.
Clinical relevance
Salivary metabolites in this study showed potential for non-invasive screening to discriminate OSCC/OED from PSOML.
https://ift.tt/2zPd7Ne
Otopathology in Angiosarcoma of the Temporal Bone
Objectives/Hypothesis
Investigate the otopathology of angiosarcoma of the temporal bone, which has not been previously described in the literature.
Study Design
Postmortem evaluation and literature review.
Methods
Postmortem histological evaluation of the temporal bones and review of the literature for the treatment and prognosis of this rare disease were performed.
Results
A 50‐year‐old male with right chronic otitis media presented with progressive hearing loss, disequilibrium, otalgia, and acute facial paresis. Biopsy of the external auditory canal was unrevealing, but specimens from a canal wall down tympanomastoidectomy later showed high‐grade angiosarcoma. Magnetic resonance imaging demonstrated an unresectable middle ear and mastoid mass extending superiorly into the temporal lobe. The patient received induction chemotherapy followed by proton beam radiation therapy and concurrent paclitaxel and bevacizumab. His course was complicated by a cerebrospinal fluid leak and cauda equina syndrome from leptomeningeal sarcomatosis. The patient died after developing meningitis and a temporal lobe abscess. Postmortem otopathology revealed persistent angiosarcoma in the internal auditory canal, although none was found in the middle ear or mastoid. There was inflammatory infiltrate throughout the mastoid, with direct extension of neutrophils and bacteria into the cochlea and through the tegmen into the middle cranial fossa.
Conclusions
Angiosarcoma of the temporal bone can arise in the setting of chronic otitis media. In this case, postmortem temporal bone sections demonstrated viable cancer despite chemoradiation. Inflammatory infiltrates crossing from the middle ear/mastoid into the labyrinth and central nervous system illustrate pathways for the development of otogenic meningitis.
Level of Evidence
4 Laryngoscope, 2018
https://ift.tt/2QpX7f8
Osteitis is associated with dysregulated pro‐osteoblastic activity in patients with nasal polyps
Objectives/Hypothesis
The overlying inflammatory mucosa plays a crucial role in the initiation of osteitis; however, the molecular mechanism is unclear. The objective of this study was to explore the bone morphogenetic protein (BMP) pathway and to correlate the expression of key signaling molecules with the degree of osteitis in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).
Study Design
Prospective experimental analysis.
Methods
This was an institutional review board–approved study in which mucosal samples were obtained from sites of osteitis in CRSwNP and compared to nonosteitic healthy controls (n = 10/group). Protein expression of key BMP pathway was quantified by aptamer‐based protein array and confirmed by a set of selected mRNA analyses. Degree of osteitis was assessed using both Kennedy Osteitis Score and Global Osteitis Score (GOS).
Results
Pro‐osteoblastic expression of BMP7 (fold change [FC] = −1.18, P = .017) and BMP9 (FC = −1.32, P = .023), their receptors, BMP receptor type‐1A (BMPR1A) (FC = −2.56, P = .005) and BMP receptor type‐2 (FC = −1.28, P = .022), and two enhancers of BMP signaling pathway, the repulsive guidance molecule domain family member B (FC = −1.13, P = .008) and the chordin‐like protein 1 (FC = −1.18, P = .027), were all significantly downregulated in CRSwNP. Conversely, the pro‐osteoclastic factor, tartrate‐resistant acid phosphatase type 5 (ACP5) (FC = 2.36, P = .001), was significantly increased in CRSwNP. GOS was inversely correlated with levels of BMP7 (r = −0.684, P = .005) and BMPR1A (r = −0.864, P = .005) and positively correlated with levels of ACP5 (r = 0.815, P = .004). The FCs among the proteins studied significantly and positively correlated with the FCs of their mRNA expression (r = 0.908, P = .002).
Conclusions
Downregulated pro‐osteoblastic mucosal BMP signaling is strongly and significantly associated with increased osteitis in CRSwNP.
Level of Evidence
NA Laryngoscope, 2018
https://ift.tt/2Qve3ks
Supraglottic Squamous Cell Carcinoma: A Population‐Based Study of 22,675 Cases
Objectives/Hypothesis
The authors used the Surveillance, Epidemiology, and End Results (SEER) database to analyze epidemiological features of patients presenting with supraglottic squamous cell carcinoma (SCCa) and to evaluate treatment trends and outcomes.
Methods
The SEER database was queried for patients with supraglottic SCCa from 1973 to 2013. Information on demographics; tumor size; histologic grade; American Joint Committee on Cancer (AJCC) stage; SEER local, regional, distant stage; and treatment modality were analyzed.
Results
There were 22,675 cases of primary supraglottic SCCa identified. The mean age at diagnosis was 62.3 years, with males accounting for 70.3% of all cases. A high percentage of patients presented with stage IV disease (44.9%). The most common treatment modality was radiotherapy (46.6%), followed by combination of surgery and radiotherapy (29.2%) and surgery alone (15.0%). Overall 5‐year disease‐specific survival (DSS) for all cases was 54.0%. When stratified by treatment modality, 5‐year DSS was best for patients receiving surgery alone (64.2%). However, for patients with AJCC stage IV disease, survival was significantly better with combined surgery and radiotherapy (52.5%).
Conclusion
In general, supraglottic SCCa is treated most commonly with radiotherapy, followed by surgery and radiotherapy. Patients managed surgically had better 5‐year DSS when compared to patients treated by other modalities. However, when stratified by stage, patients with AJCC stage IV disease had significantly better survival with combined surgery and radiotherapy. Of patients receiving surgery, supraglottic laryngectomy was found to have a significantly better 5‐year DSS when compared to both total laryngectomy and laryngectomy, not otherwise specified.
Level of Evidence
NA. Laryngoscope, 2018
https://ift.tt/2RLmG6O
Ocular Complications from Retained Intraocular Ointment Discovered 33 Months after Cataract Surgery
Topical antibiotic and steroid ointments are sometimes used topically at the conclusion of intraocular surgery, and inadvertent entry into the eye has been reported. Dispersed ointment droplets or consolidated globules in the anterior chamber (AC) can sometimes be visualized on exam. Occasionally, intraocular ointment is found incidentally without apparent toxic effect, but retained ointment usually presents with early or delayed intraocular inflammation, pressure rise, macular edema, or corneal edema. The usual treatment for toxicity from retained ointment is removal of the ointment. While the complication of ointment-induced cystoid macular edema has been reported, there is paucity of literature on the anatomical response and eventual visual outcome of patients who have been treated for long-standing edema from retained ointment. We present a case of a patient who presented with history of poor vision since the time of cataract surgery 33 months prior, who had cystoid macular edema, reduced endothelial cell count, and apparent Maxitrol ointment (neomycin, polymyxin B sulfate, and dexamethasone in paraffin vehicle; Novartis Pharmaceuticals UK) floating in the AC. The patient was treated with AC washout and sub-Tenon injection of triamcinolone. His vision, retinal architecture by optical coherence tomography, endothelial cell count, and pachymetry has been followed for 9 months following this treatment.
Case Rep Ophthalmol 2018;9:493–498
https://ift.tt/2RPoGed
Extensive Paneth cell metaplasia in an ovarian Krukenberg tumor: report of an unusual case and literature review
Abstract
Paneth cells are classified as secretory cells which are normally found in the cecum and ascending colon. Their presence in other parts of the gastrointestinal tract is regarded as abnormal and indicates metaplasia. Paneth cells may also be rarely found in gastrointestinal, biliary and prostatic tumors. The presence of Paneth cells in ovarian Krukenberg tumors is rare and to the best of our knowledge is restricted to metastatic appendiceal goblet cells tumors. We report a rare case of unilateral metastatic gastric carcinoma to the ovary in a 23-year-old female. This tumor showed unusual extensive Paneth cells metaplasia with classical signet ring cell morphology.https://ift.tt/2C52Ttu
A case series on the conservative management of the bony skull in patients with aggressive skin carcinomas of the scalp
Abstract
Few studies examine techniques of surgical resection for scalp malignancies to ensure clear margins. We present a case series utilizing outer cortex removal in patients without evidence of bony or pericranial invasion. A retrospective casenote review is presented of three cases treated in a tertiary Head and Neck Cancer Centre. An outer table removal approach was utilized based on the absence of bony involvement either on pre-operative imaging or from intra-operative findings. All cases underwent an outer table drilldown procedure. Tumour histology included high grade carcinoma of unknown origin, malignant cylindroma and squamous cell carcinoma. Complete excisions with adequate deep margins were achieved in 100% cases. Overall disease-free survival was 66.6% and local control rate was 100%. This technique allows a high degree of local control, notably at the deep margin. There is little morbidity and it avoids the complications associated with full thickness calvarial resection.https://ift.tt/2LcRtqw
Internal hernia through the foramen of Winslow
Abstract
Foramen of Winslow hernias are one of the most uncommon types of internal hernias that a surgeon will encounter. They are often initially indolent with vague symptoms that present over an extended period of time. Unfortunately, these hernias are not often diagnosed prior to requiring emergent operative intervention. This case report describes a patient who had a long history of vague abdominal pain and radiographic evidence of a foramen of Winslow hernia 4 years prior to presenting with acute obstructive symptoms. This raises the question: Should foramen of Winslow hernias, if diagnosed early, be repaired on an elective basis?https://ift.tt/2LaM6Z4
Radiation therapy quality assurance in head and neck radiotherapy – Moving forward
Publication date: January 2019
Source: Oral Oncology, Volume 88
Author(s): Lachlan McDowell, June Corry
Abstract
Head and Neck Cancer (HNC) radiation oncologists (ROs) enjoy the immense pleasure of curing patients, working within a large multidisciplinary team to effectively deliver curative intent treatment whilst also aiming to minimise late treatment toxicity.
Secondary analyses of large-scale HNC clinical trials have shown the critical impact of the quality of radiotherapy plans, where protocol non-compliant plans have yielded inferior survival rates approximating 20%. The peer review process in routine day-to-day HNC practice shows that even in major academic centers a significant proportion of RT plans may require changes to the radiotherapy planning volume.
Optimising the therapeutic ratio in HNC has been dramatically facilitated by intensity modulated radiotherapy (IMRT), but that technology has also increased the complexity of HNC radiotherapy treatment and high-volume centers with experienced clinicians may be best placed to deliver this most accurately. International consensus guidelines to standardise or benchmark best practice with respect to the RT-QA process in HNC are needed.
The aim of this paper is to highlight the importance of the RT-QA process in the HNC treatment process and to make some recommendations for its inclusion in both clinical trials and routine clinical practice.
https://ift.tt/2QtEJ57
Pediatric malignancies presenting in the head and neck
Publication date: Available online 11 December 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Jacob Kinggaard Lilja-Fischer, Henrik Schrøder, Viveque E. Nielsen
Abstract
Objectives
Childhood cancer is rare and often difficult to diagnose. In the head and neck region, benign diseases are much more common. The aim of this study was to estimate the proportion of childhood cancer cases with a primary head and neck presentation, to describe symptoms, physical findings, diagnostic interval and tentative diagnoses.
Methods
Registry-based retrospective cohort study, with patients identified in the Danish Childhood Cancer Registry. Review of medical records, imaging reports and pathology reports.
Tertiary care center
All childhood cancer patients less than 15 years of age with primary disease presentation in the head and neck region from the Central Danish Region in the years 2003 – 2013.
Proportion of patients with a primary head and neck presentation; frequency of physical findings; diagnostic intervals; and frequency of tentative diagnoses.
Results
85 patients (15% of all childhood cancers) had primary disease presentation in the head & neck region (95% confidence interval [CI]: 12 – 18%). A total of 24% (CI: 21 - 28%) of patients had any symptoms or findings from the head and neck region at presentation. Most common symptoms and findings were a swelling or a tumor, and possibly general symptoms. Diagnostic interval was more than three weeks in three out of four of patients. Primary suspicion was most commonly an infectious disease.
Conclusions
A substantial proportion of patients with childhood cancer have disease presentation in the head and neck. Worth noting is, that symptoms and findings are easily mistaken for an infectious disease, which probably explains the significant diagnostic interval.
https://ift.tt/2UBmOI3
Clinical Analysis of Pediatric Primary External Auditory Canal Cholesteatoma
Publication date: Available online 11 December 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Guanwen He, Yangbin Xu, Zhongshou Zhu
Abstract
Objective
Pediatric primary external auditory canal cholesteatoma (EACC) is a rare disease. The present study aimed to explore the clinical features and prognosis of this disease.
Methods
Clinical data of 41 ears with pediatric primary EACC were collected, and the clinical characteristics and prognosis were analyzed in this retrospective study.
Results
A total of 35 patients (median age of 13 years) were recruited in this study. Of these, 13 suffered on the left side and 16 on the other side, while 6 suffered on the bilateral ears. A total of 30 ears had hearing loss, 21 had otalgia, 14 had otorrhea, 9 had tinnitus, and 2 had pruritus. The median course of the disease was 1 month. The bone destruction of the external auditory canal (EAC) was located on the inferior wall of 20 ears, the posterior wall of 22 ears, the superior wall of 15 ears, and the anterior wall of 15 ears. According to Shin's stages, 24 ears were in stage I, 2 in stage II, 15 in stage III. A total of 40 ears underwent transcanal cholesteatoma removal (TCR) and 1 underwent both TCR and tympanoplasty. Finally, 33 ears were followed up postoperatively, and only 1 ear presented recurrence.
Conclusion
The posterior wall of the EAC is the most commonly affected wall, and the involvement of multiple walls is common. Due to the remodeling of the EAC bone in pediatric patients, the high stage lesions can be treated by minimally invasive surgical debridement combined with a close follow-up postoperatively.
https://ift.tt/2BataVD
Portable, non-powered, suction-generating device for management of life-threatening aerodigestive tract foreign bodies: Novel prototype and literature review
Publication date: Available online 11 December 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Pratik B. Patel, Nina L. Shapiro
Abstract
Objective
To present a novel approach for the emergent, pre-hospital management of life-threatening aerodigestive tract foreign body aspiration using a portable, non-powered, suction-generating device (PNSD), in the context of a literature review of emergent pre-hospital management of patients with foreign body airway obstruction.
Methods
The PubMed and MEDLINE databases were comprehensively screened using broad search terms. A literature review of pre-hospital management and resuscitative techniques of foreign body airway obstruction was performed. Further, independent measurements of PNSD pressure generation were obtained. Application of a PNSD in cadaveric and simulation models were reviewed. A comparative analysis between a PNSD and other resuscitative techniques was performed.
Results
Physiologic data from adult and pediatric human, non-human, and simulation studies show pressure generation ranging from 5.4 to 179 cm H2O using well-established resuscitative maneuvers. Laboratory testing demonstrated that a protypic PNSD demonstrated peak airway pressures of 434.23 ± 12.35 cm H2O. A simulation study of a PNSD demonstrated 94% reliability in retrieving airway foreign body, while a similar cadaveric study demonstrated 98% reliability, with both studies approaching 100% success rate after multiple attempts. Several case reports have also shown successful application of PNSD in the emergent management of airway foreign body in elderly and disabled patients.
Conclusion
PNSDs may play an important role in the emergent, non-operative, pre-hospital management of upper aerodigestive tract foreign body aspiration, particularly in settings and populations with high choking risk. Further characterization of effectiveness and safety in larger cadaveric or simulation studies mimicking physiologic conditions is indicated.
https://ift.tt/2UB97J2
Diagnostic Significance of CTCs in Patients With Thyroid Nodules (Circulating Tumor Cells)
Conditions: Thyroid Nodule; Diagnoses Disease
Intervention: Diagnostic Test: circulating tumor cells test
Sponsors: Cancer Institute and Hospital, Chinese Academy of Medical Sciences; China-Japan Friendship Hospital; Chinese PLA General Hospital; Beijing Chao Yang Hospital
Recruiting
https://ift.tt/2Px398q
Intervention: Diagnostic Test: circulating tumor cells test
Sponsors: Cancer Institute and Hospital, Chinese Academy of Medical Sciences; China-Japan Friendship Hospital; Chinese PLA General Hospital; Beijing Chao Yang Hospital
Recruiting
https://ift.tt/2Px398q
Combination Therapy With NC-6004 and Pembrolizumab in Head and Neck Cancer Subjects Who Have Failed Platinum Regimen
Condition: SCCHN
Interventions: Drug: NC-6004; Drug: Pembrolizumab
Sponsors: NanoCarrier Co., Ltd.; Orient Europharma Co., Ltd.
Not yet recruiting
https://ift.tt/2zQW0e8
Interventions: Drug: NC-6004; Drug: Pembrolizumab
Sponsors: NanoCarrier Co., Ltd.; Orient Europharma Co., Ltd.
Not yet recruiting
https://ift.tt/2zQW0e8
Siglec-8 in eosinophilic disorders: receptor expression and targeting using chimeric antibodies
Publication date: Available online 10 December 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Fanny Legrand, Yun Cao, Joshua Wechsler, Xiang Zhu, Nives Zimmermann, Shakuntala Rampertaap, Joseph Monsale, Kimberly Romito, Bradford A. Youngblood, Emily C. Brock, Michelle Makiya, Nenad Tomasevic, Christopher Bebbington, Irina Maric, Dean D. Metcalfe, Bruce S. Bochner, Amy D. Klion
Abstract
Background
Sialic acid–binding immunoglobulin-like lectin (Siglec)-8 is selectively expressed on eosinophils, mast cells and basophils, and, when engaged on eosinophils, can cause cell death.
Objective
To characterize surface and soluble Siglec-8 levels in normal (ND) and eosinophilic (EO) subjects and assess the efficacy of anti-Siglec-8 antibodies in inducing eosinophil cell death in vitro.
Methods
Eosinophil expression of Siglec-8 was assessed using flow cytometry and quantitative PCR. Serum soluble Siglec-8 levels were measured by ELISA. Induction of eosinophil death by IgG4 (c2E2 IgG4) and afucosylated IgG1 (c2E2 IgG1) anti-Siglec-8 antibodies was evaluated in vitro by flow cytometry and in vivo in humanized mice.
Results
Siglec-8 was consistently expressed on eosinophils from ND and EO and did not correlate with absolute eosinophil count (AEC) or disease activity. Soluble Siglec-8 levels were measurable in serum from most donors, unrelated to AEC or Siglec-8 surface expression. c2E2 IgG1 and c2E2 IgG4 were equally effective at inducing cell death (Annexin-V positivity) of purified eosinophils from ND and EO after overnight IL-5 priming. In contrast, killing of purified eosinophils without IL-5 was only seen in EO subjects, and NK-mediated eosinophil killing was seen only with c2E2 IgG1. Finally, treatment of humanized mice with anti-Siglec antibody led to robust depletion of IL-5-induced eosinophilia in vivo.
Conclusions
Siglec-8 is highly expressed on blood eosinophils from EO and ND and represents a potential therapeutic target for eosinophilic disorders. Enhanced killing of eosinophils in the presence of IL-5 may lead to increased efficacy in patients with IL-5-driven eosinophilia.
Graphical abstract
https://ift.tt/2QmtMSF
Incorporating Oral and Maxillofacial Surgeons on Facial Allotransplantation Teams
Publication date: Available online 11 December 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Hossein E. Jazayeri, Karan Ganjawalla, Amir H. Dorafshar, Zachary S. Peacock
https://ift.tt/2rynsZv
3D printed individual drill sleeve for depth controlled sections in third molar surgery
Publication date: Available online 10 December 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): József Szalma, Bálint Viktor Lovász, Edina Lempel, Péter Maróti
Abstract
During surgical third molar removals and coronectomy procedures, tooth sectioning is an important and, in some cases, an inferior alveolar nerve endangering step. This description introduces a drilling sleeve, which was printed according to the individual tooth sectioning situation preoperatively, using the diagnostic cone-beam CT data. The sleeve functioned in our case not only as a mark on the drill, it was a reliable physical limiter, determinant of the required depth during tooth sectioning. This fast and cost effectively produced drilling sleeve may help younger colleagues when the depth of tooth sections should be precisely controlled.
Graphical abstract
https://ift.tt/2G8QDMR
Is the Mandible Injury Severity Score a valid measure of mandibular injury severity?
Publication date: Available online 10 December 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Rodney N. Nishimoto, Thomas B. Dodson, Melanie S. Lang
Abstract
Purpose
Developing a valid method for assessing mandibular injury severity may permit standardized comparisons of treatment-specific outcomes between and among various mandibular fracture studies. The study purpose was to assess the validity of the Mandible Injury Severity Score (MISS) developed by Shetty et al by measuring the association between the MISS and postoperative complications, operative time, and length of hospital stay (LOS) following operative treatment of isolated mandible fractures.1
Materials and Methods
The investigators designed and implemented a retrospective cohort study and enrolled a sample derived from patients treated for isolated mandible fractures at Harborview Medical Center by the oral and maxillofacial surgery (OMS) service between June 2012 through December 2016. The primary predictor variable was the MISS. The primary outcome variable was postoperative complication (yes or no). Secondary outcome variables were operative time and LOS. Descriptive, bivariate, and multiple logistic regression statistics were computed to measure the association between the MISS and postoperative complications. The level of statistical significance was set at a P ≤0.05.
Results
The study sample was composed of 415 subjects with a mean age of 32.7±14.3 and 80% of subjects were male. The average MISS was 13.4±3.5 (range 6-25). The postoperative complication rate was 21%. The average MISS was significantly higher in subjects with postoperative complications than in subjects without complications (16.3±3.3 vs 12.6±3.1; P<.001). In the adjusted model, postoperative complications were significantly associated with increasing MISS (OR=1.4; 95% CI 1.3-1.6; P<.001) and open treatment (OR=7.6; 95% CI 1.6-35.6; P=0.01). MISS was positively correlated with operative time (r=.529; P<.001) and LOS (r=.114; P=0.02).
Conclusion
The results of this study suggest that the Mandible Injury Severity Score may be a valid measure of mandibular injury severity as evidenced by the positive correlation among the MISS and postoperative complications, duration of operation, and LOS.
https://ift.tt/2ryw9CQ
Polysomnographic and pulmonary function changes in patients with sleep problems after septoplasty with turbinectomy
Publication date: Available online 11 December 2018
Source: American Journal of Otolaryngology
Author(s): Yasser Mohammad Hassan Mandour, Shimaa Magdy Abo Youssef, Hany Hussein Moussa
Abstract
Object
To compare Polysomnography and Pulmonary function tests before and after Septoplasty with Turbinectomy in patients complaining of nasal obstruction and sleep problems due to deviated septum with hypertrophic inferior turbinate.
Methods
90 patients underwent Septoplasty with Turbinectomy due to nasal obstruction and sleep problems involved in this study, their sleep quality evaluated by polysomnography before and after the surgery, their pulmonary functions assessed by spirometry before and after the operation.
Results
The postoperative pulmonary function values; FVC, FEV1, PEFR and postoperative polysomonographic values; AHI, Snoring index/hour, SpaO2 were higher than the preoperative values, and the results were statistically significant (p-values <0.001).
Conclusion
Septoplasty with partial inferior turbinectomy might be a useful operation in the management of nasal obstruction and sleep problems that caused by a deviated nasal septum and hypertrophied inferior turbinate.
https://ift.tt/2C5mrhI
Buccal Fat Pad: Report of 24 Cases and Literature Review of 1,635 Cases of Oral Defect Reconstruction
ORL 2019;81:24–35
https://ift.tt/2SFl3HT
Transoral Robotic Surgery (TORS) for Bilateral Eagle Syndrome
ORL 2019;81:36–40
https://ift.tt/2QJG8ne
Gene Expression Profiles of Tumor Necrosis Factor-α and Endothelin-1 in Obstructive Sleep Apnea
ORL 2019;81:16–23
https://ift.tt/2QJG46Y
Perioperative Care of the Trauma Patient: New Concepts Since Wartime Learning
Publication date: Available online 10 December 2018
Source: Anesthesiology Clinics
Author(s): Lee A. Fleisher
https://ift.tt/2L8z3aJ
Modern Day Trauma Care for the Anesthesiologist
Publication date: Available online 10 December 2018
Source: Anesthesiology Clinics
Author(s): Maureen McCunn, Mohammed Iqbal Ahmed, Catherine M. Kuza
https://ift.tt/2C3uOKD
Propionibacterium ( Cutibacterium ) acnes Bacteriophage Therapy in Acne: Current Evidence and Future Perspectives
Abstract
Acne vulgaris is the most common dermatological disorder worldwide. It is a multifactorial disease that involves increased sebum production, hyperkeratinization of the pilosebaceous unit, Propionibacterium acnes (Cutibacterium acnes) colonization, and inflammation. The human skin microbiome hosts a wide variety of microorganisms, including bacteria, viruses, and fungi. A delicate balance of these microorganisms is essential for the barrier function of the skin. Propionibacterium acnes represents nearly 90% of the human skin microbiome of healthy adults. Acne is a chronic recurrent disease that requires long-lasting treatment, which has led to the emergence of antibiotic resistance. New alternatives to traditional therapy are emerging, including antimicrobial peptides, natural engineered antibodies, and bacteriophages. Bacteriophages have been shown to play a role in human skin health and disease. There is evidence supporting phage therapy in many types of skin infections. P. acnes bacteriophages have been isolated and characterized. However, only a few in vitro studies have tested the ability of bacteriophages to kill P. acnes. Furthermore, there is no evidence on bacteriophage therapy in the treatment of acne in humans. In this review, we summarize the most recent evidence regarding P. acnes bacteriophages and the potential role of these bacteriophages in the treatment of acne. Further research on this field will provide the evidence to use phage therapy to decrease rates of antibiotic resistance and restore antibiotic susceptibility of P. acnes.
https://ift.tt/2QGU9Cf
The long-term prognostic significance of sarcoidosis-associated pulmonary hypertension – A cohort study
Publication date: Available online 10 December 2018
Source: Clinical Immunology
Author(s): Shmuel Tiosano, Mathilde Versini, Lior Dar Antaki, Liron Spitzer, Yarden Yavne, Abdulla Watad, Omer Gendelman, Doron Comaneshter, Arnon D. Cohen, Howard Amital
Abstract
Background
Sarcoidosis is a multisystem, chronic, progressive, granulomatous disease. Sarcoidosis-associated pulmonary hypertension is a well described, but not common, complication of sarcoidosis. In small scale studies, it has been previously described as manifestation of advanced disease and was found to be associated increased morbidity and mortality. This study sought to assess the long-term prognostic significance of sarcoidosis-associated pulmonary hypertension (SAPH) by using data obtained from a large population-based registry which contains longitudinal follow-up data.
Methods
Utilizing the records of the largest healthcare provider in Israel, we extracted a cohort consisting of sarcoidosis patients and age-and-sex matched controls. Dates of sarcoidosis registration, pulmonary hypertension and death, as well as anthropometric information and medical comorbidities, were extracted from the database. A multivariate logistic regression model was used to find variables associated with pulmonary hypertension. Cox proportional hazards method and log-rank test were used for survival analysis.
Results
The cohort included 3993 sarcoidosis patients and 19,856 controls. Pulmonary hypertension was observed among 269 sarcoidosis patients (6.74%) vs. 400 controls (2.01%). Sarcoidosis was found as independently associated with pulmonary hypertension (OR 3.17). After a mean follow-up of 7.49 years (median 7.24, maximum 17.88 years), 710 (17.8%) of the sarcoidosis patients and 2121 (10.7%) of the controls had died. Both sarcoidosis and pulmonary hypertension were found to be significantly associated with an increased risk of all-cause mortality (HR 1.82 and HR 2.31, respectively).
Conclusions
SAPH is associated with a poor prognosis. Proper screening methods may assess whether early identification and treatment improve life expectancy.
https://ift.tt/2zTbi1H
The kaleidoscope of autoimmunity – From genes to microbiome
Publication date: Available online 10 December 2018
Source: Clinical Immunology
Author(s): Yehuda Shoenfeld, Michael Ehrenfeld, Ori Perry
Graphical abstract
https://ift.tt/2zW77Cp
Microbial transglutaminase: A new potential player in celiac disease
Publication date: Available online 10 December 2018
Source: Clinical Immunology
Author(s): Lerner Aaron, Matthias Torsten
Abstract
Microbial transglutaminase is heavily used in the food processing industries to improve food qualities. Being a protein's glue, by cross-linking it creates neoepitope complexes that are immunogenic and potentially pathogenic in celiac disease. Despite low sequence identity, it imitates functionally its family member, the endogenous tissue transglutaminase, which is the autoantigen of celiac disease. The present comprehensive review highlights the enzyme characteristics, endogenous and exogenous intestinal sources, its cross-talks with gluten and gliadin, its immunogenicity and potential pathogenicity and risks for the gluten induced conditions. If substantiated, it might represent a new environmental inducer of celiac disease. The present findings might affect nutritional product labeling, processed food additive policies and consumer health education.
https://ift.tt/2Px54cW
Intravenous Immunoglobulin (IVIG) in the vanguard therapy of Systemic Sclerosis
Publication date: Available online 10 December 2018
Source: Clinical Immunology
Author(s): João Pedro Gomes, Lèlita Santos, Yehuda Shoenfeld
Abstract
Systemic Sclerosis (SSc) is a rare autoimmune disease that is characterized by a progressive skin fibrosis, an obliteration of the microvasculature and an exaggerated extracellular matrix deposition, which lead to a multisystemic dysfunction. Various pathogenetic mechanisms were described. The lack of a successful therapy make SSc a disease with a poor prognosis. The intravenous immunoglobulin (IVIG) has been used for a long time in different autoimmune diseases, and firstly used in SSc patients in 2000. IVIG has multiple non-specific mechanisms of action and, beyond an impressive improvement in muscle symptoms, a French nationwide cohort demonstrated that IVIG ameliorates the skin disease and systemic inflammation, and helps the daily dose corticosteroid's tapering at the end of the treatment. The benefits on gastrointestinal symptoms of IVIG was reported by a recent English article, in which the patients consistently reported a decrease in the gastro-esophageal reflux disease symptoms and their frequencies. The impact on the lung involvement still remains unclear. One of the advantages of IVIG is its safe profile. Few adverse effects were reported and most of them are mild, and can be managed and usually they do not relapse. Harmful effects were described, but they can be avoid with cautious and judicious use of this therapy.
https://ift.tt/2zUjf70
The role of synthetic manufactured peptides containing common citrullinated epitopes in rheumatoid arthritis diagnosis
Publication date: Available online 10 December 2018
Source: Clinical Immunology
Author(s): Saeed Darawshe, Abdulla Watad, Nicola L. Bragazzi, Smadar Gertel, Howard Amital
Abstract
Background: Anti-citrullinated peptide antibodies (ACPA) play an important role in rheumatoid arthritis (RA) diagnosis. In our study, we sought to assess the potential diagnostic value of synthetically manufactured peptides that contain epitopes believed to have a pathogenic role in RA.
Methods: Serum samples from RA patients and healthy controls were obtained. Two synthetic peptides were manufactured containing the common epitopes considered to play a pivotal role in the RA pathogenesis including the antigenic epitopes of filaggrin, beta-fibrinogen, collagen, vimentin and enolase. Three different ELISA kits for citrullinated peptides (namely: CCP3, Cit-ME-Vim and Cit-ME-Eno) were tested and compared. To assess the diagnostic value of the three ELISA tests, for each test the optical densities (OD) were recorded. The statistical power of each test was calculated measuring the area under the curve (AUC) corresponding with each peptide.
Results: Serum levels of ACPA recognized by the commercial CCP3 in RA and healthy controls were 1.31 ± 0.88 optic density units (ODU) and 0.21 ± 0.11 ODU, respectively. Cit-ME-Vim levels were 0.55 ± 0.46 ODU in RA subjects and 0.17 ± 0.182 ODU in healthy controls whereas Cit-ME-Eno was 0.61 ± 0.65 ODU in RA subjects and 0.22 ± 0.20 ODU in healthy controls. AUC results were as follows: CCP3, 0.89 [95%CI 0.75–0.87]; Cit-ME-Vim, 0.76 [95%CI 0.69–0.82]; Cit-ME-Eno, 0.73 [95%CI 0.65–0.79]. Statistical significance for all results was achieved (p < .0001). Sensitivity values for each kit are as follow: CCP3 70.42%; Cit-ME-Vim 63.38%; Cit-ME-Eno 40.85%, and specificity 91% for all tests.
Conclusion: Our study supports the presence of an added value for the Cit-ME-Vim peptides in the diagnosis of RA. Further studies are needed to replicate such findings.
https://ift.tt/2Px4HPs
Autoimmune and angiogenic biomarkers in autoimmune atherosclerosis
Publication date: Available online 10 December 2018
Source: Clinical Immunology
Author(s): Emese Balogh, Anita Pusztai, Attila Hamar, Edit Végh, Szilvia Szamosi, György Kerekes, Jennifer McCormick, Monika Biniecka, Sándor Szántó, Gabriella Szűcs, Zoltán Nagy, Ursula Fearon, Douglas J. Veale, Zoltán Szekanecz
Abstract
Several inflammatory, proteolytic, angiogenic and bone-associated factors play a role in the development of autoimmune, accelerated atherosclerosis in rheumatic diseases. Some of these may serve as biomarkers of vascular pathology and may be useful in the follow-up of vascular damage and outcome. Multi-biomarker profiles rather than a single markers would likely be optimal in this respect.
https://ift.tt/2zSG0YM
Autoimmune interstitial lung disease in Latin-America
Publication date: Available online 10 December 2018
Source: Clinical Immunology
Author(s): F. Vivero, F. Campins, D. Lancellotti, P. Malfante, S. Babini, J. Sebastiani, V. Basso, A. Gaser, J. Enghelmayer, E. Gandara, EPIMAR Group
Abstract
Information about the prognosis and natural history of autoimmune interstitial lung diseases (Ai-ILD) is limited. The aim of the study was to evaluate the characteristics of patients diagnosed with Ai-ILD in Latin-America. We conducted an ambispective multicenter cohort study in 25 centers of Argentina, Colombia, and Uruguay between January 2015 and April 2018. Participants were included in the study if they had diagnosis of Ai-ILD performed by a multidisciplinary team. Patients were classified into the following sub-groups: connective tissue disease-associated ILD (ILD-CTD), interstitial pneumonia with autoimmune features (IPAF), and positive antineutrophils cytoplasmatic antibodies associated ILD (ILD-ANCA). All images were reviewed by a blinded thoracic radiologist. Out of the 381 patients included during the study period, 282 (74%; 95% CI; 69.39–78.16) were women. Mean age was 58 years old (DS 16). Three-hundred and twenty-five (85.1%; 95% CI 81.39–88.5) patients were classified as ILD-CTD (rheumatoid arthritis 31%, systemic sclerosis 29%, dermatomyositis 15%). Thirty-six patients were classified as IPAF (9.5%; 95% CI 6.9–12.8), and 13 (3.5%; 95% CI 2–5.75) as ILD-ANCA. Fifty percent of patients (95% CI 45.12–55.43) had a mild decrease of the forced vital capacity at the time of diagnosis. The most common treatment strategy was the combination of steroids and cyclophosphamide (30.1%; 95% CI 25.32–35.34) followed by azathioprine (20,3%; 95% CI 16.32–25.14). In conclusion, to the best of our knowledge, this is the first study to evaluate the characteristics and treatment strategies used in patients affected by Ai-ILD in Latin-America. Future studies should to evaluate the prognosis and impact of current treatment strategies in patients with Ai-ILD.
https://ift.tt/2Pz6hRf
Relapsing Evans syndrome and systemic lupus erythematosus with antiphospholipid syndrome treated with Bortezomib in combination with plasma exchange
Publication date: Available online 10 December 2018
Source: Clinical Immunology
Author(s): Olga Tkachenko, Sergey Lapin, Alexey Maslyansky, Valentina Myachikova, Liya Mikhailova, Boris Gilburd
Abstract
Relapsing Evans syndrome (ES) and systemic lupus erythematosus (SLE) with secondary antiphospholipid syndrome (APS) is very rare association. Coexistence of these syndromes is potentially fatal and require high-dose combined immunosuppressive therapy. We describe a case of successful use of Bortezomib and plasma exchange in a patient with ES and APS refractory to standard therapy. Thirty-two-year-old male who presented episodes of relapsing hemolytic anemia, pancytopenia and multiple thrombosis with positive direct and indirect antiglobulin test result, lupus anticoagulant and medium titer of anti-beta-2-glycoprotein 1 and anti-cardiolipin antibodies was diagnosed with ES and SLE with secondary APS. High-dose therapy by steroids and Cyclosporin A were started with temporary improvement. There was also no stable improvement with Rituximab and Cyclophosphamide. Bortezomib in combination with cyclosporine A and plasma exchange was introduced. He had stable improvement in hematological parameters with no evidence of relapse of hemolytic crisis or thrombosis during a follow-up for 1 year.
https://ift.tt/2zONc8o
T cell receptor revision and immune repertoire changes in autoimmune diseases
Publication date: Available online 10 December 2018
Source: Clinical Immunology
Author(s): Xi Jia, Bing Wang, Tianyu Zhai, Qiuming Yao, Qian Li, Jin-an Zhang
Abstract
Autoimmune disease (AID) is a condition in which the immune system breaks down and starts to attack the body. Some common AIDs include rheumatoid arthritis, systemic lupus erythematosus, type 1 diabetes mellitus and so forth. The changes in T-cell receptor (TCR) repertoire have been found in several autoimmune diseases, and may be responsible for the breakdown of peripheral immune tolerance. In this review, we discussed the processes of TCR revision in peripheral immune environment, the changes in TCR repertoire that occurred in various AIDs, and the specifically expanded T cell clones. We hope our discussion can provide insights for the future studies, helping with the discovery of disease biomarkers and expanding the strategies of immune-targeted therapy.
https://ift.tt/2PxsezN
Insights from the 11th International Congress on Autoimmunity, Lisbon, Portugal, 2018.
Publication date: Available online 10 December 2018
Source: Clinical Immunology
Author(s): Abdulla Watad, Nicola Luigi Bragazzi, Yehuda Shoenfeld
https://ift.tt/2PtOlqR
The loss of tolerance to CHI3L1 – A putative role in inflammatory bowel disease?
Publication date: Available online 10 December 2018
Source: Clinical Immunology
Author(s): Claudia Deutschmann, Dirk Roggenbuck, Peter Schierack
Abstract
The incidence of inflammatory bowel disease (IBD) is steadily increasing. IBD is characterized by a chronic inflammation of the gastrointestinal tract and is classified into the two main groups Crohn's disease (CD) and ulcerative colitis (UC). Genetic predispositions, environmental factors and a dysregulated immune response are known to part take in the onset of IBD. However, their etiopathogenesis is still not fully understood. In the last decade, there is growing evidence of the involvement of the 18- glycosylhydrolase family member Chitinase-3-like protein 1 (CHI3L1) in IBD. CHI3L1 is associated with various diseases including cancer and chronic inflammatory conditions like rheumatoid arthritis, IBD and even neurological disorders where it can act as a chemotractant, mitogen or growth factor. In this review will focus on the role of autoimmunity to CHI3L1 in IBD in the context of its expression in inflamed colonic epithelia and interaction with intestinal microbiota. It will further provide insight into the interaction of CHI3L1 with different mechanisms of the innate and adaptive immune response in IBD.
https://ift.tt/2Px4EDg
Subglottic stenosis due to chronic lymphocytic leukemia
Publication date: Available online 10 December 2018
Source: Acta Otorrinolaringológica Española
Author(s): Ryoko Watanabe, Kosei Kageyama, Kenta Watanabe
https://ift.tt/2SEhYHZ
Vagales Paragangliom mit anatomischer Rarität der Blutversorgung
Laryngo-Rhino-Otol 2018; 97: 871-872
DOI: 10.1055/a-0747-7001
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
https://ift.tt/2QrfakM
Der Stimmlippenpolyp
Laryngo-Rhino-Otol 2018; 97: 836-837
DOI: 10.1055/a-0652-7085
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
https://ift.tt/2RLNVOF
Pacta sunt servanda – Zur Durchsetzung von Berufungs- und Bleibezusagen
Laryngo-Rhino-Otol 2018; 97: 873-874
DOI: 10.1055/a-0652-7107
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
https://ift.tt/2QotsCJ
Hypopharynxkarzinom: OP nach Lokalrezidiv kann Überlebenschance verbessern
Laryngo-Rhino-Otol 2018; 97: 828-829
DOI: 10.1055/a-0677-5438
Chu PH et al. To do or not to do: salvage management for hypopharyngeal cancer after chemoradiation therapy. Eur Arch Otorhinolaryngol 2018; doi:10.1007/s00405–018-5042–0 Hypopharynxkarzinome werden meist spät entdeckt und haben von allen Kopf-Hals-Tumoren die schlechteste Prognose. Hat sich eine Kombination aus Radiochemotherapie bislang als effektiv erwiesen, werden Bergungsoperationen nach Rezidiven aufgrund hoher Komplikationsraten noch diskutiert. Chu und Team haben nun mit einer retrospektiven Datenanalyse untersucht, wie sich Operationen nach Radiochemotherapie auf das Überleben auswirken.
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© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2RQYxfg
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